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Patient satisfaction is a key indicator of inpatient care quality and is associated with clinical outcomes following admission. Different patient characteristics have been inconsistently linked with satisfaction. This study aims to overcome previous limitations by assessing which patient characteristics are associated with satisfaction within a large study of psychiatric inpatients conducted across five European countries.

Methods

All patients with a diagnosis of psychotic (F2), affective (F3) or anxiety/somataform (F4) disorder admitted to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and the UK were included. Data were collected from medical records and face-to-face interviews, with patients approached within 2 days of admission. Satisfaction with inpatient care was measured on the Client Assessment of Treatment Scale.

Results

Higher satisfaction scores were associated with being older, employed, living with others, having a close friend, less severe illness and a first admission. In contrast, higher education levels, comorbid personality disorder and involuntary admission were associated with lower levels of satisfaction. Although the same patient characteristics predicted satisfaction within the five countries, there were significant differences in overall satisfaction scores across countries. Compared to other countries, patients in the UK were significantly less satisfied with their inpatient care.

Conclusions

Having a better understanding of patient satisfaction may enable services to improve the quality of care provided as well as clinical outcomes for all patients. Across countries, the same patient characteristics predict satisfaction, suggesting that similar analytical frameworks can and should be used when assessing satisfaction both nationally and internationally.

It remains contested whether peacekeeping works. The impact of peacekeepers’ actions at the local subnational level for overall mission success has lately received critical attention. Local peacekeeping is expected to matter because it reassures local actors, deters resumption of armed hostilities, coerces parties to halt fighting, and makes commitment to agreements credible. Thus peacekeepers affect the relations between central and local elites and avoid the emergence of local power vacuums and areas of lawlessness. This study uses new subnational data on the deployment of United Nations peacekeepers. It uses matching and recursive bivariate probit models with exogenous variables for temporal and spatial variation to deal with possible nonrandom assignment of the treatment. We demonstrate that conflict episodes last for shorter periods when peacekeepers are deployed to conflict-prone locations inside a country, even with comparatively modest deployment. The effect of peacekeeping on the onset of local conflict is, however, less clear cut.

United Nations (UN) peacekeepers tend to be deployed to ‘hard-to-resolve’ civil wars. Much less is known about where peacekeepers are deployed within a country. However, to assess peacekeepers’ contribution to peace, it matters whether they are deployed to conflict or relatively safe areas. This article examines subnational UN peacekeeping deployment, contrasting an ‘instrumental’ logic of deployment versus a logic of ‘convenience’. These logics are evaluated using geographically and temporally disaggregated data on UN peacekeepers’ deployment in eight African countries between 1989 and 2006. The analysis demonstrates that peacekeepers are deployed on the frontline: they go where conflict occurs, but there is a notable delay in their deployment. Furthermore, peacekeepers tend to be deployed near major urban areas.

Previous studies identified several domestic factors that may influence a country’s level of structural coup-proofing, i.e., counterbalancing strategies that shall prevent internal groups from seizing power via a coup d’état. We suggest that a country’s level of counterbalancing is also affected by such policies in what we term countries’ “peer groups.” When deciding the appropriate level of counterbalancing, rulers may be affected by external information flows from a “peer group” with similar structural coup-risk characteristics (institutions) or a similar coup-risk experience (coup history). Using maximum likelihood spatial lag models and data in 1976–2005, we find that leaders learn from and emulate counterbalancing in other states, but rather only through an “experiential peer group.”

For a given number of troops in a peace operation, is it advisable to have soldiers from a single country, or should the UN recruit peacekeepers from a variety of donor countries? Since 1990, the number of contributors to peace operations has grown threefold, and most operations have carried the mandate to protect civilians. This article explores the effect of diversity in the composition of a mission, measured by fractionalization and polarization indices, on its performance in protecting civilians in Africa in the period 1991–2008. It finds that mission diversity decreases the level of violence against civilians, a result that holds when geographic and linguistic distances between countries are considered.

Aims – To evaluate the quality of psychiatric care during the acute psychotic episode and the early post-acute period. Methods – Data concerning 24 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT's Project to evaluate the implementation of NICE recommendations in Italian Mental Health Services. Results – The treatment of the acute episode in the Italian Mental Health Services is not based only on admissions in Psychiatric Ward in General Hospitals, but also on intensive home based care. The utilization of day hospital facilities for treating acute episodes is less frequent, as the presence of home based follow up after discharge. About of Departments of Mental Health did not have clinical guidelines concerning the pharmacological treatment in this area. However usually the standard practices followed NICE recommendations in terms of prescribed dosages, monitoring side effects and rationale for shifting to atypical antipsychotic drugs. Antipsychotic drugs, atypical or conventional, were frequently prescribed concurrently, while utilization of atypical antipsychotic drugs was increasing. Conclusions – The results show critical points concerning on one hand the scarce diffusion of clinical guidelines, on other hand the connection between standard practices, clinical guidelines and marketing of atypical antipsychotic drugs. It should be reinforced the role of the community and particularly at service level the capacity of community mental health teams to treat the acute patients.

Aims - This study aims to present data on structural and human resources of public mental health services located in the Veneto Region, Italy, and to discuss them in the light of implementation of the first National Target Plan for Mental Health (“Progetto Obiettivo 1994-1996”) ten years after its launch. Methods - The study was conducted in the context of the PICOS (Psychosis Incident Cohort Outcome Study) Project, a large first-presentation multisite study on patients with psychotic disorders attending community mental heath services in the Veneto Region. Human and structural resources were surveyed in 26 study sites using a structured interview administered by the PICOS local referents. Results - CMHCs and Day Centres were homogeneously distributed across the Region and their overall rates per resident population met the national standards; a wide variability in the distribution of Day Hospitals was found, with the overall rate per resident population very far from meeting the national standard; the overall rate for Residential Facilities beds was higher than the recommended national standard, showing however an high variability across sites. The overall rate of mental health professionals per resident population was only slightly below the national standard: this was mainly achieved thanks to non-profit organizations which supplement the public system with unspecialised professionals; however, a wide variability in the local rates per resident population was found, with the 50% of the sites showing rates far lower the national standard. Specific lack of trained professionals involved in the provision of psychosocial interventions was found in most sites. Conclusions - A marked variability in human and structural resources across community mental health services in the Veneto Region was found. Possible reasons for this heterogeneity were analysed and implications for mental health care provision were further discussed.

This study was designed to investigate the effect of both hypertension and ageing on the efficiency of glucose metabolism. A 12-sample, 120 min intravenous glucose tolerance test (IVGTT) was applied to 36 rats: two groups of nine young (12 weeks) spontaneously hypertensive and Wistar Kyoto rats (Y-SHR and Y-WKY group, respectively) and two groups of nine old (40 weeks) SHR and WKY rats (O-SHR and O-WKY group, respectively). Insulinaemia and glycaemia data were interpreted in terms of estimates of glucose effectiveness, SG, and insulin sensitivity, SI, provided by the minimal model of glucose kinetics. The possible link between insulin resistance and hypertension was investigated by comparing Y-SHR vs. Y-WKY and O-SHR vs. O-WKY groups. Comparison of O-SHR vs. Y-SHR and O-WKY vs. Y-WKY groups enabled us to investigate the role of age in the development of abnormalities in glucose metabolism. No significant differences (P > 0.05) were observed in the mean SG and SI estimates between SHR and age-matched WKY groups. This finding indicates that exposure of SHR to high blood pressure levels does not necessarily lead to the development of insulin resistance and impaired glucose effectiveness. Similarly, no significant differences (P > 0.05) were observed in SG and SI estimates between old and young SHR and WKY groups. This finding indicates that, in this animal model of hypertension, insulin sensitivity and glucose effectiveness do not even deteriorate with ageing. Experimental Physiology (2003) 88.3, 399-404.

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